The Neck and Back Pain Cycle
Neck and back pain is a result of many types of injuries and potential causes, including motor vehicle accidents, lifting injuries, pregnancy, arthritis, disc, and joint disorders to name a few. The initial cause of the pain routinely leads to a “diagnosis” but what is not often times explained is the pain cycle that all of these causes and diagnosis create, and more importantly how to break the cycle of pain.
Regardless of the initial cause or diagnosis, most neck and back injuries will enter a familiar cascade of secondary effects from pain, which is referred to as “the pain cycle”. Pain in the body, especially pain lasting more than a few days or weeks can create secondary effects to the musculoskeletal system which leads into more pain.
Pain creates decreased activity and movement, as the body’s natural response is to guard the injured area, providing rest and healing. However, after the first 24-48 hours of an injury, this lack of motion can start creating more problems than good. If prolonged lack of activity ensues, the more secondary weakness and range of motion loss can be expected.
- Pain guarding, spasm, and lack of normal muscle activity of damaged structures leads to weakness and muscle inhibition.
Weakness can stem from lack of physical activity, but additionally (and more likely) is from muscle inhibition. The nervous system becomes alarmed during the pain cycle, and actually sends less signals to the affected muscle area. Lack of the ability for muscles to normally contract and relax is called muscle inhibition. In low back pain, the multifidus (low back), lower abdominals, and other support muscles have been shown to be inhibited. A study found that a lack of strength of the support muscles by 10% can actually increase strain to the joints and ligaments by 65%. So you can see, weakness of the support muscles will lead to more pain.
- Muscle inhibition leads to faulty movement patterns, compensation, muscle imbalances, and weakness of postural support muscles.
Tissue changes now occur within the affected muscle areas, and sometimes even include muscles away from the injury site, due to compensation. It almost seems that what started as a local pain has now spread. Some muscles tighten and shorten, as scar tissue develops. Others weaken and shrink, or atrophy.
- Adaptive shortening of tight muscles and atrophy of weakened muscles occurs over time. Postural pain develops or increases.
Lack of range of motion, tightness, and poor movement patterns seem almost permanent. More pain, and now inability to bend, lift, turn the head or trunk, and other daily functions are impaired.
- Myofascial adhesions (scar tissue) envelopes once normal muscle tissue, and creates lack of range of motion, tightness, pain, and loss of function.